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Flashcards in Midterm I Deck (48)
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Name the four stages of swallowing:


Oral Prepatory

Oral Transit







What events take place in the oral prepatory phase?




Bolus formation

Bolus maintenance





Cranial Nerve V innervates which muscles during the oral prep stage?




masseters, temporalis, pterygoid muscle





Aside from the salivary glands, CN VII innervates which muscles of mastication?

orbicularis oris, zygomatic major/minor, superior levator labii, mentalis, risorius, caninus, depressor anguli





The salivary glands are innverated by which two Cranial Nerves?









When does the oral "voluntary" phase officially begin?




When tongue begins to propel the bolus posteriorly





Explain in detail what happens during the Oral "voluntary" phase:

After the bolus has been formed through the help of the muscles of mastication and dentition, the tongue will propel the bolus to the back (oropharynx).  In doing so, the tongue tip and sides will pan on alveolar ridge.  Next the soft palate elevates and the tongue base drops.  Pressure is exerted by the tongue, once the bolus reaches the ramus of the mandible, bolus enters the pharyngeal stage





How long does the oral phase take?



1 - 1.5 sec

*.3 sec longer for persons over 60





The pharyngeal phase of swallowig involves the complex interaction of:




tongue, velopharynx, and larynx




Once the tonuge elevates, velopharyngeal closure begins, which triggers:



forward motion of the hypolaryngeal to increase opening of UES (upper esophageal sphincter); larynx elevates, and relaxation of cricopharyngeus musculature





What mechanisms occur during the Pharyngeal Phase?

Velar elevation

Base of Tongue Retraction

Vocal fold adduction

sequential contraction of pharyngeal constrictors

epiglottis retraction/inversion

laryngeal/hyoid elevation and hyoid movment

constriction of the laryngeal vestibule

opening/relaxation of the cricopharyngeus





Explain Pharyngeal Transit


base of the tongue retracts and contacts with the posterior pharyngeal wall

followed by a sequential contraction of upper, middle, and inferior constrictors

bolus moves downward via a combination of gravity, base of tongue retraction, and pharyngeal contraction





What are the four mechanisms of airway protection?

Hyoid/laryngeal elevation

Epiglottic retroflexion

Adduction of the true vocal folds

Closure of the laryngeal vestibule or additus
Epiglottis retroflexion
false vocal cord adduction
true vocal cord adductioni
anterior movement of arytenoid cartillages





Explain in detail how epiglottic retroflexion works:

suprahyoid, mylohyoid, and geniohyoid muscles are responsible for the anterior movement of the hyoid and tipping of epiglotts to a horizontal position

-base of tongue contributes to horizontal movement

elevation of larynx to approximate hyoid results in moving of epiglottic in vertical position





What happens during closure of the laryngeal vestibule?



anterior tilting of the arytenoids

false vocal fold adduction

laryngeal elevation





True or False:

The upper esophageal sphincter (UES) is a tonically contracted group of skeletal muscles separating the pharynx from the esophagus









True or False

The UES at rest is in state of tonic contraction








True or False:

Elevation of the larynx pulls the UES open: fibers of the cricopharyngeus are attached anteriorly to the laminae of the cricoid cartilage









What happens during the Esophageal Stage?



Peristalsis: sequential contraction of the esophagus and relaxation of the LES

*bolus is propelled through the by contraction above and relaxation below the bolus (descending inhibition)





Name some of the age-related changes in swallowing:

sense of taste is diminished (reduced sensory input due to dysphagia)

percentage of dippers increase

increase in amount of oral/pharyngeal residue 

increase in transient penetration, but not incidental aspiration

greater delay during swallow

decrease in laryngeal elevation = decreased UES opening




True or False:

The changes seen in the elderly in regards to swallowing means that they have "less reserve" and may be more prone to aspiration when severely ill









Name some of the populations that are higher risk for having Dysphagia:


Cerebral Vascular Accident (patients)

Dementia & other neurodegenerative diseases

Head & Neck cancer 

Hospitalized patients

Cardiac conditions: coronary artery bypass graft






What is the purpose of a bedside clinical swallow?


-screening for possible dysphagia

-determine the physiologic factors contributing to dysphagia

-determine for need of other tests

-make recommendations for safest means of food intake





What are some of the clinical findings or signs of a patient with dysphagia?

coughing/choking while eating or drinking

frequent throat clearing

wet vocal quality


edentulous (missing teeth/no teeth)

SOB (shortness of breath)

spiking a temperature

increased time to complete a meal

oral residue




True or False:

If patient is alert you should not do an exam









What are you looking for when doing an oral-mech exam?

examining the sensory/motor functions of CN: V, VII, IX, X, and XI

checking for structural integrity of lips, jaw, tongue, hard palate, and velum

oral hygiene

strenght, range of motion, coordination, speed, direction of muscles in lips, tongue, jaw, and velum

Palatal reflex (stroke soft palate)

Gag reflex





Describe in detail how you would perform an exam testing CN V, VII, X, and XII

CN V: bite down to feel bulk on side (masseter)
*open mouth a bit and place finger on chin and ask them close

CN VII: ask person to purse lips (check for lip seal)

CN X: look at someone's mouth when they say aaaaa / glottal coup

CN XII: movement of tongue, have their tongue push against your finger 




As you're conducting the oral mech exam, what are some signs you should be looking out for?


check for the strength/presence of voluntary cough

quality/quantity of secretions

signs of apraxia/dysarthria/hypophonia

rapid/shallow breathing

ability to initiate dry swallow

palpate for layrngeal elevation




True or False:

If you do decide to feed, you can start with a tsp of water or whatever is easiest








As you're doing the feeding, what are some things you need to look out for?

lip closure (drooling)

delay of initiation of swallow

overt coughing or choking (before/during/after) swallow

laryngeal elevation during swallow

wet-gurgle voice after swallow

oral residue after swallow